Ganglion(s) and Swellings

Ganglions are the most common type of swelling in the hand. They contain a thick clear liquid called synovial fluid.

Although ganglions can arise from any joint or tendon tunnel, there are four common locations in the hand and wrist – in the middle of the back of the wrist; on the front of the wrist at the base of the thumb; at the base of a finger, and on the back of a finger end-joint.

Ganglions occur when synovial fluid leaks out of a joint or tendon tunnel and forms a swelling under the skin, although the cause of these leaks is not known. In some cases ganglions are painful, in others they are not.

What surgery is available, and what techniques are involved?

Ganglions are harmless and can be safely left alone. However, for people who want to get rid of a ganglion, treatments options vary depending on the location of the swelling and the symptoms it is causing.

The liquid contents of a ganglion can be removed with a needle (a procedure known as aspiration). However, the most definitive treatment is the surgical removal, or excision, or the ganglion in its entirety.

What can I expect as a patient?

Surgery can usually be done under local anaesthetic, with numbing injections which avoid the need for general anaesthetic. The ganglion is then excised. Removal of a ganglion close to the nail involves tracing it down to the joint and, in most cases, removing a small bone-spike. There is also often a shortage of skin in this part of the hand, which is best treated by moving skin from further down the finger, using a local flap.

The post-surgery scar is usually inconspicuous, but may become red and thick especially on the front of the wrist. Ganglions are known to recur on occasions, but can be removed again, still with a good chance of success. As with all operations on the hand, there is a small possibility of unexpected stiffness, swelling or pain requiring physiotherapy or other treatment.

Following the removal of a ganglion from the wrist, a bulky dressing or plaster splint will be applied. You will be encouraged to move the fingers regularly to avoid stiffness, and you will be able to move the wrist after 10-14 days. This might need to be supervised by a hand therapist. The usual recovery time following ganglion surgery ranges from two-to-three weeks for a small finger cyst, to six-to-eight weeks for wrist ganglions.